Midwives/Homebirth in the News

I was reading about this annual celebration of our work and discovered that it was established in 1992! Almost 25 years of celebrating midwives and the incredible care they provide pregnant and birthing people, and their families, all over the world. The International Confederation of Midwives spearheads this celebration. Separately and together, Christy and Jenni have celebrated International Day of Midwife in many different places and with lots of different activities.

a) Hosting our monthly group prenatal at our office, with (as always) food demo’d by Christy and discussion facilitated by the three of us. Our topic this week is newborn care and early postpartum norms.

b) Feeling grateful for midwifery knowledge and the home birth of Haven, now ten months old and making things very exciting at our house.

d) Appreciating the ever-growing skills and general fabulousness of our apprentice, Chandra Fisher. We are lucky to have her and I know that our current and past clients appreciate her involvement in their care at prenatals and births.

f) Getting ready for the launch of midwifery-model culturally-appropriate prenatal education with the Mama Sana/Vibrant Woman clinic opening in June. Paula Rojas, a former apprentice with MotherBloom and now a Licensed Midwife, is integral to this project; Christy is a midwife advisor and Jenni is providing volunteer technical support with the use of an EHR.

Thank you for continuing to support us both in doing this amazing work.

Childbirth Connections has done it again! They have put together an evidence-based, very readable and user friendly tool explaining the importance of physiologic birth and the role hormones play when the body is allowed to gestate, labor, birth and breast feed without interventions. This report highlights the significant negative effect that stress (physical, emotional, financial, racial, etc) can have on people in all cultures who are pregnant and birthing their babies when they do not feel supported or nurtured. The Childbirth Connections website is full of useful information for both families and providers, please see the links below for some of the most pertinent documents.

Today marks the long-anticipated publication of two articles on the outcomes of the Midwives Alliance of North America Statistics Registry (MANA Stats).

We are very excited to share with you the findings – and how you can help spread the word. But first, the findings:

Key findings of the study

This is the largest ever look at planned home births in the U.S., examining nearly 17,000 births.

This study joins a growing body of research that shows that, for low-risk women, home birth with a skilled midwife is a safe option that has health benefits for mothers and babies.

The study has implications far beyond home birth, because it shows the benefits of normal physiologic birth, which can be supported in any setting.

Today’s study – unlike recent anti-home birth research that relies on birth certificate data – is based on the MANA Stats registry. The MANA Stats registry contains high-quality data that uses the gold standard – the medical record – instead of birth certificate data, which is notoriously unreliable for studying intended place of birth and newborn outcomes.

More detailed findings

For planned home births with a midwife in attendance, key outcomes include:

Over 93% women had a normal physiologic birth

A cesarean rate of 5%

Only 2.5% of babies admitted to the NICU in the first six weeks of life

87% of women with previous cesareans had their babies vaginally

Of the 10.9% of women who transferred from home to hospital during labor, the majority moved for non-emergent reasons, like a slow, non-progressing labor, or maternal exhaustion

At six weeks postpartum, nearly all babies were breastfed

While we can’t make a direct comparison to hospital outcomes (because they include women with different risk factors), we are happy to see such low intervention rates and high breastfeeding rates without increasing risk to mother and baby.

Rates of fetal and newborn death were very low for babies without congenital anomalies: the risk of death to the fetus or newborn (including during labor, in the first week of life, or the first 28 days of life) was about 2 per 1,000.

The risk of fetal and newborn death are even lower when women in higher-risk categories were excluded. When breech, previous cesarean, multiples, preeclampsia, and gestational diabetes were removed, the risk of death was about 1.6 per 1000. These rates are in line with other well-designed studies that look at home birth. In particular, babies born in the breech position appear to have the highest risk.

At the conclusion of midwifery care, 98% of babies were being breastfed; 86% were exclusively breastfed. Nationally, only 77% of babies even begin breastfeeding, and we know how important this is to the lifelong health of babies and their mothers.

We need your help to spread this good news!

We’ve all read about the poorly designed research or data releases that suggest home birth isn’t safe. Opponents of a woman’s right to choose her place of birth have made sure those numbers have been widely spread. But together, we can ensure that women receive the accurate information they need to make well-informed decisions about their health care.

Here’s how you can help

First, you can learn more by reading our summary of findings here on the MANA blog. While you are there, please stop by the comments section and leave a note.

Next, share the blog post widely on your Facebook page, on listservs, and with your community.

While you are on Facebook, please consider stopping by the MANA page and sharing some of the visuals we designed to help educate consumers about the research. Please leave a comment too; every comment you leave means more people will learn about the positive outcomes of midwifery.

You can also find a link to a fact sheet about the research to share with consumers over at the Citizens for Midwifery site.

Please join us in gratitude

Please join us in thanking the many, many people who have made this possible, including the homebirth midwives who have diligently contributed to the MANA Stats database.

We also thank the members of the MANA Division of Research who created the system, continually improved it over the years, and have put quality assurance processes in place to make sure the data are sound.

Interesting points: St. David’s Hospital in Austin has a much higher c/section rate than I anticipated- wowza!; the c/section rate in the Texas valley is extremely high-way over the national average ….I can’t help but think racial/economic discrimination is at play; and you’ll notice that the birth center study I posted about a few days ago had a VBAC success rate that far surpasses the rate of any of the hospitals listed here.

The outcomes for mothers and babies are excellent and comparable to other out-of-hospital birth settings in other countries. The only disappointment is that because of exclusion protocols at most birth centers in the US, there were only 56 cases of vaginal birth after cesarean (VBAC) attempts in the study of 15, 574 births. 70% of the women did successfully VBAC, but unfortunately this is not a large enough VBAC cohort to give us new information to further validate the safety of VBAC in home or birth center settings.

A friend sent me this link of 20 of the Best Midwife Blogs for 2012 and my MotherBloom website/blog made the list! The other blogs listed are popular and substantial with great information and stories. Check it out : 20 OF THE BEST MIDWIFE BLOGS

I am always puzzled about why the midwifery model of care and homebirth, both things that are so intuitively right to me, continue to be scrutinized and squabbled over in the medical world. For the latest rebuttal to the American Journal of Obstetrics and Gynecology most recent anti-homebirth article click HERE. Thank you Wendy Gordon, Sharon Muza, and Science and Sensibility for posting.

New CPM Policy Brief

With input from leadership of multiple stakeholder groups* and in collaboration with the Council on Adult and Experiential Learning www.cael.org, NARM presents the following Policy Brief that focuses on the competency based certification model for health professions.

Policy Recommendations:
In order to validate and support CPMs as a critically needed part of our primary maternity care system, and to establish greater accountability for births at home and in birth centers, state legislators and other policy makers need to:

Establish licensure based on the CPM credential

Provide oversight of CPMs through a board of midwifery or advisory council/board within existing oversight boards, comprised mostly of licensed midwives and having the authority to set guidelines for CPM practice

Establish reporting requirements

We invite the entire midwifery community to download, read and share this important document and integrate these concepts into advocacy and policy efforts for the promotion of midwife-led care in the US.

Today at Urban Market at 12th and Chicon in East Austin, a new pregnancy clinic was launched. Mamas of Color Rising has worked very hard to get this new type of pregnancy care clinic open, Vibrant Woman Pregnancy Clinic / Mama Sana Clinica Prenatal. In collaboration with a few Austin midwives and Blackstock Family Health Clinic, the Mamas are offering free pregnancy testing and group prenatal care to African-American and Latina women. This beautiful mural, painted today by graffiti artist Toofly, signifies the opening of the clinic! Read more HERE.

If you are interested in Vibrant Woman Pregnancy clinic / Mama Sana Clinica Prenatal or want to learn more about the care being offered,